Chirurgie pediatrique最新文献

Two cases of haemorrhagic renal cysts in neonate are reported. Both cases were premature newborns with obstetrical difficulties and delayed tumoral syndrome. The first case was considered a solitary renal cyst. The surgical procedure was a prominent domme resection. Four years later a contralateral Wilm's tumor appeared which became bilateral in 12 months, terminating in death 3 months later. The second case is clinically and radiologically similar in the neonate period. The surgical procedure was a nephrectomy. Compared histological reading of both resection materials, allowed us to establish diagnosis of congenital cystic nephroma. Cystic wall cells were normal elements of Bolande's tumor, of which microcystic forms have been soon reported. Hypothesis in our two cases would be mesoblastic nephroma in a pure cystic form, which would allow to widen morphologic spectrum of Bolande's tumor.

A 15 year old boy presents two fractures of the left inferior member (femur and tibia), after a motor-cycle accident. An osteosynthesis by plate and screws was performed, in emergency. In immediate post-operative days, a radicular paresia of the left inferior member appear especially on exterior popliteus sciatic nerve. The electromyogram confirm the diagnosis. However, these is nor pain nor fracture of the sacro-lumbar spine. The consolidation of femur and tibia fractures is normal. The neurologic recuperation is slow but progressive. A year after the accident, because the recuperation is not complete, an MRI is performed. An arachnoidal cyst surrounding the L5 and S1 roots is diagnosed. The surgery is decided. The ablation of the cyst is performed in the same operative time that the ablation of plate. The histology of the paries of the cyst confirm, by hemosiderimic deposits, the traumatic etiology. The arachnoïdal cyst is rare, particularly in the childhood. It is always difficult to know the relation between the cyst and the symptom. It is also impossible to be certain of traumatic etiology: traumatic cyst or traumatised cyst? The surgical indication is lawful by the existence of clinical signs, because 50 per cent of cases are improved or recovered.

Fifteen cases of sacrococcygeals teratomas were treated at our hospital over the last ten years. There is no correlation between prematuration and tumor weight, as between tumor weight and low babys' weight. High tumoral weight didn't influence the prognosis. The treatment is always surgical. Chemotherapy was used only for recurrence in one case (the patient is dead). For all the cases, we performed a perineal procedure without abdominal procedure. No patient had an abdominal extension of the teratoma.

22 axial corrections of limbs in children were performed using the Ilizarov technique between 1984 and 1986. This prospective study has been performed under the auspices of the Association pour l'Etude Systémique et l'Application de la Méthode d'Ilizarov en France (ASAMIF). Total correction of deformity was achieved in 20 cases. A minimal angulation (less than 5 degrees) was observed in two cases. In 9 cases tibia or femoral lengthening was performed simultaneously. After corticotomy and placement of the stimulant effect of limb distraction. The mean lengthenings achieved was 30 mm. Serious complications were are: there was one case of fracture of the regenerating bone. We deplore only two superficial pin track infections, two cases of rarefaction of bone. The bone consolidation was obtained on an average of two months. If inequality was associated (more than 40 mm) technique of double corticotomy was performed. The best and more results were certainly performed in great deformities. On the other hand the Ilizarov method addresses all inequalities of leg length, whatever the aetiology, who are associated with common deformity.

In order to obtain a better understanding of the anorectal continence in the newborn child, the development of the anorectal sphincter was studied in 25 embryos (3 to 60 mm CR), sectioned in the sagittal, transversal and frontal planes. A macroscopic study was also performed in 20 human embryos, completed by a light microscopic study and by a morphometric analysis of the smooth and striated components of the sphincter. The anorectal sphincter is composed of three parts: the external sphincter, which appears in the early embryos as a condensation of mesenchymal tissue around the anorectum. It receives smooth longitudinal fibers later; the m. puborectalis appears before 10 weeks and forms a sling around the anorectum; the internal sphincter, which is only well differentiated at 10 weeks and grows after the rupture of the anal membrane. This study emphasizes the importance of the anorectum in the development of its own sphincter.

The authors report 4 new cases of heterotopic pancreas in children with prepyloric, jejunal, Meckel's diverticulum and mesenteric localization. Clinical manifestations were: hemorrhage in the prepyloric localization, abdominal pain in the mesenteric and Meckel's diverticulum and ileus in the jejunum localization. The authors emphasise the difficulties of preoperative diagnosis of the pancreatic heterotopias, owing to their usually small size and the necessity of surgical treatment.

In order to clarify the indications of MAGPI procedure (Meatal Advancement and Glanuloplasty Incorporated), 18 patients operated upon have been reassessed after a long follow-up (mean: 30 months). The cosmetic and functional results are good in 16 cases, 2 non-satisfactory results are noticed with a wrong meatal position. The initial position of the meatus (glanular or coronal), the absence of chordee and the initial aspect of the glans (broad and flat) are the three main conditions to obtain a good result.

Since skin problems as decubitus and infections are well known risks in osteoplastic trepanations in congenital malformations in children, we searched for a reduction in size of the implants and the possibility to use biodegradable materials. After design of special constructions regarding dimension and stability purposes for children below one year, we performed osteoplastic trepanations in 27 minipigs. In 78% the healing was uneventful and the osteoplasty remained in place whereas in 22% (= 6 animals) we observed a local infection which lead to loss of implants as well as cranioplasty in 3 animals. Based on this research, we used our biodegradable implants in osteoplastic trepanations of congenital craniostenosis in children. The postoperative follow-up is now from 3 to 6 months in 4 children and the results are perfect in all. We did not observe any local infection, neither cutaneous problems, even not in bilateral frontal advancement and floating forehead procedures. The implants are presented as well as the results in animal research and the first follow-up in 4 children.

The rapidly growing possibilities of prenatal diagnosis and intrauterine manipulation of the malformed fetus have created the need for animal experimental models as simple and easy to handle as possible. We report on our experience with the induction of body wall defects in the chick embryo. Laparoschisis was produced by evisceration of the bowel through the umbilical stalk and its exposition to the allantoic fluid at the 14th day of incubation. Exomphalos, Cantrell's Pentalogy and Spina Bifida were induced by sterile aspiration of 5 ml of egg albumen at the 24th hour of incubation. All embryos were recovered and studied at the 19th day of incubation. The results can be summarized as follows: ninety-four (51%) of the 184 embryos operated for bowel exteriorization survived and 42 (45%) had intestinal lesions identical to those found in human laparoschisis. Two-hundred ans seventy (45%) of the 602 embryos treated by albumen extraction survived and 197 (73%) had no visible malformations, whereas either exomphalos or Cantrell's pentalogy were found in 37 (14%) and spina bifida was observed in the remaining 36 (13%). All lesions were strikingly similar to the human ones. These models could facilitate research on the above-mentioned malformations without the major difficulties and expenses inherent to fetal research in mammals. The chick embryo, for many decades a favorite model for embryologists, is a tool for fetal research as well and opens some perspectives in this field even for relatively modest laboratories.

Report of four cases of congenital defects of the scalp. In two of these cases, the skin defect was associated with a skull defect and in one, there were other cranial deformities. In each case, the lesion seemed isolated in otherwise normal children. This study contains a review of congenital scalp defects. The different aspects of this rare disease are presented and the treatment is discussed with reference to natural evolution. The authors differentiate between cases with isolated lesion and cases with associated malformations or abnormalities, malformation syndromes, as has been previously defined. In the case of skull defects, it is thought that immediate reparatory surgery must be performed, to prevent infection and hemorrhage of sagittal venous sinus, as it was the case in one of the four children. The covering of the defect can be realized with rotated skin flaps, which seem preferable to any form of plastic surgery, for cosmetic reasons, and for the secondary treatment of the skull defect, if this is necessary. When spontaneous closure of the bone defect, is not noted, which occurs generally in the case of large defects, it seems reasonable to close the latter by cranio-plasty, to protect the brain. In one of the four cases reported, this technical approach of the lesion was used, with a good result being reported, four years later.